Message In Motion Clinic Registration

Parent Name *

First

Last

Email *

I have reviewed and agree to the Message In Motion Clinic Policies. *

Yes No

Student Name *

First

Last

I understand no refunds are given unless enrollment minimums are not met or enrollment maximums have already been met. *

Yes No

I understand there are risks inherent in any physical activity and will not hold the school and/or facility in which the clinic is held and/or Message In Motion LLC liable in the event of injury or otherwise. While my child is participating in Message In Motion Clinic, I agree to assume full responsibility for any and all personal injuries and/or property damage or loss which I, or my child, may sustain thereby. *

Yes No

I give permission for my child to be photographed at Message In Motion Clinic and I give permission for these photographs to be anonymously used in marketing related to Message In Motion. I understand that my child’s name will never be published. *

Yes No

In the event of an emergency, I give my permission for the Message In Motion staff and/or volunteers to obtain emergency medical treatment for my child. I understand that, if necessary, my child will be transported by ambulance to the nearest medical facility. I agree that any cost incurred for any transportation and/or treatment will be my responsibility. I give my permission to Message In Motion staff to provide my child minor first aid treatment should the need arise until I can be notified and/or other higher level medical care is available. *

Yes No

What our parents & schools say:

"I thought you should know about your program's continued positive impact on Danielle. She has been very busy this summer with activities and camps, and she enjoyed yours the best! While you have most assuredly taught Danielle a lot about dance these last two years, you have also instilled in her valuable principles and skills. I thought you should know.
-Barry J (parent)

Message In Motion Dance Clinic Registration

Student Information

Clinic Policies-
Important! Please take a moment to read.

Clinic Waiver

Clinic Payment